Name of Organization:

Address:

City:

Province/State:

Postal Code:

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Phone:
(include international code)

Phone 2:
(include international code)

Fax:
(include international code)

e-mail address:

Web Site:

How would you describe your organization?
(University, Language Institute,
Volunteer organization, ESL Website,
Recruitment Agency, etc.)
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What age group does your organization generally serve?
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Describe business activities of your organization:
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Legal Name of Organization:

Organization is a: Sole proprietorship
 Corporation
 Partnership
 Trust
 Limited Liability Corporation
 Non-Profit Organization
 S-Corporation
 Corporation

 Other (please specify)
 

Who owns the Organization?:

How many years has it been in operation?:

Date organization was established:

Please list any established associations that accredit or recognize your organization:
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How many students, on average, do you anticipate enrolling in TEFLOnline.com via your organization per year?
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Courses

Please list all of the courses that are currently offered by your organization, including any language courses, test preparation courses, specialized courses, and other teacher certification courses:
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Objectives

Why is your organization interested in offering TEFLOnline.com? Explain how both your organization and BridgeTEFL would benefit from a partnership. Identify key synergies:
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Administration

Authorized Resellers must appoint a staff member to act as liaison between reseller and BridgeTEFL.
Please indicate name and contact information for this person:

Name:

Title:

Phone(s):

e-mail:

Signatures

 I authorize the verification of the information provided above.

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